Question 1

A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most likely cause of these symptoms?

A) Allergic pharyngitis
B) Group A streptococcus
C) Infectious mononucleosis
D) Viral pharyngitis

D

Accepted Answer

The sudden onset of symptoms, mild erythema of the pharynx, and clear rhinorrhea without cervical lymphadenopathy are consistent with viral pharyngitis. Allergic pharyngitis would have more significant erythema and congestion of the pharynx, as well as other signs of allergic reaction. Group A streptococcus would cause more severe erythema and exudate in the pharynx, often with fever and cervical lymphadenopathy. Infectious mononucleosis would have more significant pharyngeal erythema, exudates, and lymphadenopathy, as well as extreme fatigue and splenomegaly.

Question 2

A patient presents with sore throat, a temperature of 38.5&#176;C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient's symptoms?&#10;A) Order an anti-streptolysin O (ASO) titer.&#10;B) Perform a rapid antigen detection test (RADT).&#10;C) Prescribe empirical penicillin.&#10;D) Refer to an otolaryngologist.

Accepted Answer

The patient's symptoms are consistent with a diagnosis of streptococcal pharyngitis, and the most appropriate next step is to perform a rapid antigen detection test (RADT) to confirm the diagnosis. If the RADT is positive, the provider can prescribe empirical penicillin. If the RADT is negative but the provider still suspects streptococcal pharyngitis, an anti-streptolysin O (ASO) titer can be ordered. Referral to an otolaryngologist is not necessary at this point.

Question 3

A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year. The child's parent asks the provider if the child needs a tonsillectomy. What will the provider tell this parent?

A) Current recommendations do not support tonsillectomy for this child.
B) If there is one more episode in the next 6 months, a tonsillectomy is necessary.
C) The child should have radiographic studies to evaluate the need for tonsillectomy.
D) Tonsillectomy is recommended based on this child's history.

A

Accepted Answer

The American Academy of Otolaryngology-Head and Neck Surgery's guidelines for tonsillectomy recommend at least seven episodes of tonsillitis in one year, five episodes per year for two consecutive years, or three episodes per year for three consecutive years before considering tonsillectomy. Based on this child's history, they do not meet the criteria for tonsillectomy.

Deck 83: Pharyngitis and Tonsillitis